Info
🌱 來自: Huppert’s Notes
Intracranial Hemorrhage🚧 施工中
Intracranial Hemorrhage
Epidural hematoma
• Etiology: Rupture middle meningeal artery due to head trauma. Can have periods of unresponsiveness with interval lucidity; CSF is often yellow because bilirubin is present (xanthochromia)
• NCHCT: Convex, lens-shaped hematoma that respects suture lines
• Treatment: Reverse coagulopathy, consult neurosurgery, craniotomy may be indicated
Subdural hematoma (SDH)
Acute subdural
• Etiology: Head trauma resulting in injury to small bridging veins
• NCHCT: Crescent shaped hematoma that crosses suture lines
• Treatment: Reverse coagulopathy, consult neurosurgery, craniotomy may be indicated
Chronic subdural
• Etiology: Typically occurs in elderly patients or patients on anticoagulation who have mild head trauma
• NCHCT: Crescent-shaped hematoma
• Treatment: Reverse coagulopathy, consult neurosurgery, can sometimes observe or may need craniotomy
Subarachnoid hemorrhage (SAH)
• Etiology: Ruptured aneurysm or due to an AV malformation (e.g., in the setting of Marfan’s syndrome, ADPKD), trauma, arterial dissection
• Symptoms: “Worst headache of my life,” meningismus, focal neurologic deficits, encephalopathy, seizure
• Diagnosis: NCHCT, LP needed to definitely rule out if head imaging is negative
• Treatment: Reverse coagulopathy, consult neurosurgery, maintain SBP goal <140 mmHg, nimodipine, clip or coil aneurysm
• Complications: Rebleed (highest risk during the first 24 hr), vasospasm (highest risk 3–14 days after SAH), hydrocephalus, seizures, hyponatremia (SIADH)
Intracerebral hemorrhage (ICH)
• Etiology: Intraparenchymal bleed, which is most often due to hypertension
• Symptoms: Focal neurologic symptoms and then signs of ↑ICP (somnolence, vomiting, headache, bradycardia, hypertension, coma)
• Diagnosis: CT angiogram, repeat NCHCT at 6 hours
• Treatment: Reverse coagulopathy, consult neurosurgery, maintain SBP < 160 mmHg